A clever pill to swallow

It’s reminiscent of Fantastic Voyage, the sci-fi story (both a film and a novel) in which a team of scientists gets tiny and travels through a human body to fix a blood clot. But in real life there are these little pill/cameras that can take pics of what’s going on in the digestive system, from the inside instead of endoscopically, a relatively minimally invasive way of diagnosing intestinal ills. Instead of going under sedation and having the colon probed from that end, you swallow a largish “pill” and wear a special belt and harness for a few hours while the camera travels through your gut, snapping pics.

The latest development in this futuristic technology is Olympus’ Endocapsule, which visualizes the small intestine by the use of a pill-shaped camera and an antenna belt that gets a wireless video signal from the capsule and shows video of the photos on a handheld device that controls it. Improvements on the new Endocapsule include a lighter, smaller over-clothes harness that is said to be more comfortable than previous systems that required being placed directly on the skin. More developments include a 160-degree field of view, a twelve-hour battery life and a three-dimensional tracking function that shows the progress of the capsule either in real time or downloadable for later.

In 1868 German physician Dr. Adolph Kussmaul figured out how to illuminate the process of endoscopy when he examined an open-throated sword swallower, using a light source made of an alcohol and turpentine mixture. However, until 1970 barium x-rays were used much more, in part due to the unpleasant nature of having a scope pushing against the powerful gag reflex, although sometimes inflatable scopes helped with that.

Although Olympus introduced the world’s first gastrocamera in 1950, several other companies have jumped on board since then. Given Imaging, from Israel (now being bought by an Irish company), introduced the M2A, or PillCam, in 2001. And later the same year the Japanese did them one better with the NORIKA3 that turned digestive forces into power to fuel the capsule with an on-board generator. Three years later Given Imaging came back with a capsule that could see the esophagus, and a year after that a Japanese company RF Comp Ltd introduced Sayaka, with higher resolution images. But at that time the large intestine was still unexplored by camera capsules, with nothing yet FDA-approved, mostly because of the folded nature of the organ, which allows growths to hide unseen by the cameras. So the endoscope, with air to puff up and unfold the tube, was still the best bet. But since it got FDA approval earlier this year, Given Imaging’s PillCam Colon can go through the large intestine in about eight hours, taking photos at close to four frames a second, increasable to six — remotely — if it’s going too fast. While some other capsules are still powered by mini-generators, the Colon uses a battery, so it’s a little bigger than its predecessors. The MIRO from the Korean company Kist can also see the large intestine. And Japan has been working on “Mermaid” capsules that can “swim” into the intestinal folds by use of a flapping tail.

Conditions that might call for capsule endoscopy include symptoms like bleeding, chronic abdominal pain, or unexplained anemia or weight loss that can be the result of digestive disorders like inflammatory bowel diseases or benign or malignant tumors. Although benefits of these devices include less discomfort or need for sedation or surgery, as well as less radiation exposure, one risk is a potential loss of the capsule necessitating surgical removal.

The device is contraindicated in patients with pacemakers or other cardiac electronic devices, who have any structural abnormality in the intestine that would hinder the passage of the pill, and for people who are pregnant or have swallowing disorders. And if the traveling capsule finds anything suspicious — a growth or a polyp — it can’t just snip it out as during the traditional endoscopic procedure.